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Early postnatal dexamethasone increases the risk of focal small bowel perforation in extremely low birth weight
P Gordon1, J Rutledge, R Sawin
1Department of Pediatrics, University of North Carolina, Chapel Hill, USA.
Insights
Early dexamethasone prophylaxis (EDP) significantly increased the risk of focal small bowel perforation (FSBP) in extremely low birth weight infants. Indomethacin did not appear to be a risk factor for this serious condition.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Pharmacology
Background:
- Spontaneous pneumoperitoneum and focal small bowel perforation (FSBP) are serious complications in extremely low birth weight (ELBW) infants.
- Early dexamethasone prophylaxis (EDP) is used to prevent bronchopulmonary dysplasia in ELBW infants.
Purpose of the Study:
- To identify risk factors for FSBP in ELBW infants, particularly in relation to early dexamethasone prophylaxis (EDP) and indomethacin use.
Main Methods:
- A case-controlled study analyzed 51 ELBW infants (< 1001 gm) over 13 months.
- Infants were grouped based on treatment with dexamethasone and/or indomethacin.
- Relative risk and confidence intervals were calculated; surgical specimens underwent pathological examination.
Main Results:
- Infants receiving EDP had a 12.3-fold increased relative risk of perforation compared to untreated infants.
- Indomethacin treatment showed a comparable risk of perforation to no indomethacin.
- Pathology confirmed FSBP with loss of muscularis externa; no infections were identified.
Conclusions:
- Early dexamethasone prophylaxis (EDP) is identified as a significant risk factor for focal small bowel perforation (FSBP) in ELBW infants.
- Indomethacin is not implicated as a risk factor for FSBP in this population.
Objective:
We observed two clusters of spontaneous pneumoperitoneums in extremely low birth weight infants during the use of a protocol for early dexamethasone prophylaxis (EDP) for bronchopulmonary dysplasia from 1996 to 1997. During surgery, focal small bowel perforation (FSBP) was found in eight of nine cases. A retrospective study was designed to identify risk factors for FSBP in these extremely low birth weight infants.
Methods:
A case-controlled analysis was performed using all infants born weighing < 1001 gm and admitted to the University of Washington Medical Center Neonatal Intensive Care Unit during a 13-month period. A total of 51 infants were identified and divided into groups based on treatment or not with dexamethasone and indomethacin. These cohorts were homogeneous for gestational age, birth weight, and perinatal stability. Relative risk and confidence intervals were calculated for each of the comparisons. Routine pathology was performed on all surgical specimens and additional sections were cut and stained for further study.
Results:
Infants who received EDP had a relative risk of perforation that was 12.3 times that of untreated infants. Those treated with indomethacin had a risk that was comparable with that for infants who did not receive indomethacin. Infants who received both EDP and indomethacin tended to have higher rates of pneumoperitoneum than infants who received EDP alone but comprised a cohort too small for valid analysis. The pathology of surgical specimens revealed FSBP with segmental loss of the muscularis externa. There was no evidence of fungal or bacterial infection in any of the surgical specimens.
Conclusion:
These findings implicate EDP, but not indomethacin, as a significant risk factor for FSBP.
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